JULY 2007 – Researchers in Charleston have come up with a surgical technique that has at least three direct benefits to the patient.

The human brain fits nicely inside the skull under normal circumstances. But when it begins to swell because of something like a traumatic injury, it doesn’t have anywhere to grow. Increased pressure inside the head then results in brain damage or death. The traditional surgical treatment is to remove a large section of the skull for up to weeks or months. Surviving patients are then subjected to additional surgical procedures to replace the removed bone flap that has either been frozen or placed inside another part of the body for storage.

This new technique, called hinge craniotomy, is for patients with swelling that was not treatable with medication.

Dr. Schmidt uses titanium bone plates in a hinged fashion to allow the brain to swell while keeping it protected. The head is gently wrapped with gauze and after a few weeks, with relaxation of brain swelling the hinged bone flap returns to a more normal anatomical position.

“Cosmetically, the appearance of the patient’s head is good and protection of the brain results from this procedure,” Schmidt said. “No helmet is needed in the postoperative period.”

“We know of no reports of a surgical technique for the replacement of the bone flap using titanium bone plates in a ‘hinge’ fashion such as this one,” said Bernardo Reyes, MD, CCI , CAMC Health Education and Research Institute.

Cutline for figure (CAMC Today July 2007)
The illustration demonstrates the technique of using hinges to secure the bone flap to surrounding skull allowing decompression of the swollen brain.